Value of laser therapy, photodynamic therapy, and follow-up observation in the management of cervical low-grade squamous intraepithelial lesions: a prospective cohort study
10.3760/cma.j.cn112141-20240725-00414
- VernacularTitle:激光和光动力治疗及随访观察在子宫颈低级别鳞状上皮内病变管理中的意义一项前瞻性队列研究
- Author:
Lu ZHANG
1
;
Fanting MENG
;
Jiangnan WU
;
Long SUI
;
Qing CONG
Author Information
1. 复旦大学附属妇产科医院宫颈与阴道早期疾病诊疗中心，上海 200011
- Keywords:
Squamous intraepithelial lesions of the cervix;
Papillomavirus infections;
Laser therapy;
Photochemotherapy;
Follow-up studies;
Cohort studies
- From:
Chinese Journal of Obstetrics and Gynecology
2024;59(11):848-855
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the value of CO 2 laser therapy, photodynamic therapy, and follow-up observation in the management of cervical low-grade squamous intraepithelial lesion (LSIL). Methods:Women diagnosed with cervical LSIL and high risk human papillomavirus (HR-HPV) infection through colposcopy-guided biopsy from January 1, 2021 to December 31, 2023 were collected. According to a 1∶1 ratio, 107 cases were included in each of the laser treatment, photodynamic therapy, and follow-up groups. The complete remission rate and HR-HPV clearance rate were compared during the 6-12 months follow-up period.Results:(1) Comparison of clinical data among the three groups before treatment: the median age of the 321 patients was (34.9±8.1) years. Before treatment, cytological abnormalities were present in 51.7% (166/321) of patients, and 35.2% (113/321) had human papillomavirus (HPV) 16/18 infections. The accuracy rate of colposcopic diagnosis was 69.2% (222/321). Age, cytology results, HPV 16/18 infection, and colposcopy diagnosis in the laser group, photodynamic group, and follow-up group were compared, and there were not statistically significant differences (all P>0.05). (2) During the 6-12 months follow-up period, the complete remission rate was 89.7% (96/107) in the laser group, slightly higher than the 86.9% (93/107) in the photodynamic group, with no statistical difference between the two groups ( χ2=0.41, P=0.523). However, both were significantly higher than the 64.5% (69/107) in the follow-up group ( χ2=19.30, P<0.001; χ2=14.63, P<0.001). The HR-HPV clearance rates in the laser and photodynamic groups were 73.8% (79/107) and 68.2% (73/107), respectively, both significantly higher than the 32.7% (35/107) in the follow-up group ( χ2=36.34, P<0.001; χ2=26.99, P<0.001), but with no statistical difference between the laser and photodynamic groups ( χ2=0.82, P=0.366). Conclusions:CO 2 laser therapy and photodynamic therapy are effective treatments for cervical LSIL, significantly superior to follow-up observation in terms of lesion remission and HR-HPV clearance rates. Individualized treatment plans could be developed based on the patient′s age, duration of HR-HPV infection, colposcopic impression, and economic conditions.
